Physical Therapy Post ACL Repair: Improving Muscular Strength and Range of Motion
An Anterior Cruciate Ligament (ACL) sprain, more commonly referred to as an ACL tear, can happen to anyone from pro football athletes to youth soccer players. The ACL is a very important stabilizer of the knee; when injured, it is enough to stop any athlete in their tracks. To maximize results and avoid complications following ACL injury, it’s essential to assure that the early stages of physical therapy go well.
If torn, the ACL will not heal on its own. Surgery may or may not be required, but either way a referral to physical therapy will be. Some key elements of physical therapy following ACL injury and repair include reducing swelling and inflammation, restoring range of motion, improving strength and increasing mobility.
Anterior Cruciate Ligament Injury: Who’s at Risk?
According to the American Academy of Orthopedic Surgeons, football, basketball and soccer players, especially those who participate in sports that involve in fast movement in multiple directions, have an increased risk for ACL injuries. However, it’s not just athletes who are at risk of the injury.
An ACL injury occurs when the extremity is unable to withstand the stress of a pivoting movement resulting in the knee collapsing inwards. ACL injuries have the potential to occur during any activity, such as making a quick turn when running after one’s children, trying a new fitness class involving quick changes of direction. Even something as simple as unexpectedly stepping in a hole or off a curb wrong can result in the ACL failing to protect the knee.
As we age, a reduction in strength and speed of movement can increase the risk for an ACL injury. Additionally, orthopedic studies confirm that female athletes have a two to 10 times greater risk of injuring their ACLs than males in activities such as basketball and soccer. This is particularly due to poor lower extremity functional movement control during fast changes of directions while participating in these level 4 activities. Physical therapy has been demonstrated to improve the individual’s ability to control the lower extremities against stresses that could cause an ACL injury.
Are you at risk for an ACL injury?
We can help you answer that question with a simple physical assessment of your ability to control your lower extremities as you land from a jump or changing direction when running. Core control is critical for utilizing the most effective muscles to be able to assume a squat position during such maneuvers. Proper squat mechanics dramatically decreases the risk of an ACL injury.
Physical Therapy After ACL Injury or Repair
Physical Therapy following ACL injury or repair is an essential part of a full recovery. Ideally, rehabilitation program will be initiated immediately after injury. Depending on the individual, some will be able to avoid surgery with rehabilitation alone. However, for those who do require ACL surgery, rehabilitation prior to surgery has been demonstrated to result in better functional outcomes from rehabilitation after ACL reconstruction surgery.
Since pain and swelling will limit your strength and range of motion, the first step in rehabilitation is to reduce inflammation and decrease any pain associated when initially injured and later after surgery, if needed. Starting conservatively, physical therapy interventions may include modalities such as cold compression combined with electrical stimulation to control pain and swelling.
Restoring Range of Motion
After ACL injury or surgery, it’s important to restore and maintain full range of motion (ROM) in the knee as soon as possible. Typically, extension (straightening) tends to be more difficult than flexion (bending) but restoring motion through physical therapy will allow the knee to function properly. Through manual therapy techniques, such as patellar mobilization, the physical therapist works to restore full functional knee ROM.
An altered gait is typical in the first stages post ACL injury and surgery. The first days of ACL rehabilitation focuses on restoring level 3 independent ambulation. Commonly affecting gait cadence are restrictions in knee flexion and extension. Therapeutic activities are used to gain appropriate knee movement for a functional gait pattern. Neuromuscular reeducation and proprioceptive exercises are included in the plan of care to enhance stability of the extremity by stimulating the quadriceps and hamstring muscles to normal functional patterns.
The primary impairments following an ACL injury are instability in the knee and atrophy in both slow and fast firing muscle fibers. Physical therapy protocols will range from endurance training program of low loads and high repetitions to strength-oriented activities of high loads and low repetitions performed rapidly. A comprehensive program allows for a return to typical level 3 endurance activities of moving about home and community, to level 4 activities requiring fast firing fibers to allow a return to high intensity, multidirectional activities.
Return to Activity
Depending on the complexity of the injury and the individual’s progress, gradual return to strenuous level 4 activities will take between six months to up to a year. The individual must be pain-free and able to demonstrate appropriate strength, endurance, and agility necessary for a return to previous level 4 activities.
If you have experienced an ACL tear or are suffering from knee pain, contact our top physical therapy specialists at Twin Boro in New Jersey to obtain a consult and get the treatment you deserve.
Visit one of our physical therapy clinics to learn more about how physical therapy can help you. With 42 locations throughout New Jersey, we make it easy to find a physical therapy clinic near you. Simply search for your closest location using your zip code.
Why Choose Twin Boro Physical Therapy
Voted Readers’ Choice Best of New Jersey in 2013, Twin Boro has provided NJ residents with high quality physical therapy and rehab for over 38 years! It’s our award-winning approach, proven results and reputation that sets us apart. By incorporating the One2Four program into each patient’s program, the latest and most reliable scientific research and techniques is incorporated into effective evidence-based practice, we deliver only the highest standard of care with the unique One2Four approach.
It’s no surprise that Twin Boro Physical Therapy has also been voted the best physical therapy practice in New Jersey by the readers of mycentraljersey.com.